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The Removal Of The X-Waiver: What It Means For Pain Medicine Practitioners

It is now easier to prescribe buprenorphine to patients with opioid use disorders.

prescription

During the recent State of the Union address, President Joe Biden mentioned a law that simplifies prescribing opioid addiction treatments. He was referring to the X-Waiver, which had been around for over 20 years before it was done away with on December 29, 2022.

“With the signing of the Consolidated Appropriations Act of 2023, Congress eliminated the DATA-Waiver Program,” states the Drug Enforcement Administration (DEA)’s website. “The elimination of the X-Waiver will increase access to buprenorphine for those in need.” 

With the waiver, doctors had to jump through multiple hoops (training, audits, a patient limit) if/when they prescribed the drug. Therefore, as the vice president for research at UT Health San Antonio, Jennifer Potter, told NBC News, health professionals had been waiting for its removal for “years if not a decade or more.”

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CDC rolls out the 2022 Clinical Practice Guideline for Prescribing Opioids for Pain

New guideline provides evidence-based recommendations to help patients and clinicians make informed, patient-centered decisions about effective pain care.

Pain is one of the most common reasons adults seek medical care here in the United States. All patients with pain should receive safe, effective, and informed pain care options. CDC has released a new guideline to support patients and clinicians in reaching their goals for pain care and function.

CDC’s 2022 Clinical Practice Guideline for Prescribing Opioids for Pain, which updates and replaces the 2016 CDC Guideline, is a clinical tool to improve communication between clinicians and patients and empower them to make collaborative, individualized, and informed decisions related to pain care. It provides 12 voluntary recommendations for clinicians providing pain care and includes expanded guidance for treatment of acute and subacute pain. The 2022 Clinical Practice Guideline incorporates new evidence to help primary care and other clinicians weigh the risks and benefits of a full range of pain treatment options, including prescription opioids.

The release of the 2022 Clinical Practice Guideline is an important step towards promoting safe and effective pain care. Share and promote the 2022 Clinical Practice Guideline and related resources:

Additional Overdose and Opioid Resources

Where are they now? See Previous Winners!

 Where are they now? Read what previous Case Study and Scholarship winners have been up to...

Previous Winner of the 2020 Hassenbusch Continued Learning Case Study Presentation and 2021 Hassenbusch Continued Learning Scholarship

George Polson MD Case Study and Scholarship WinnerGeorge Polson MD
Case Study (2020) – PM&R Residency at Baylor College of Medicine
Scholarship (2021) – PM&R Residency at Baylor College of Medicine (Accepted to MD Anderson Pain Medicine Fellowship)

In what ways have you used what you presented in your recent practice?
While the case study I presented involved the use of Peripheral Nerve Stimulation for Hemiplegic Shoulder Pain, during my fellowship training we have found a multitude of other clinical uses for this new technology, all of which ultimately has led to better patient outcomes. It is exciting to be a part of all the innovation and treatment options that neuromodulation has to offer!

What professional development have you gone through since your award? 
              As of July 2022, I have begun my Pain Fellowship training at MD Anderson Cancer Center

Where are you working now? 
              The Texas Medical Center in Houston, TX

What's one piece of advice you'd give to a Fellow going into PM? 
Take advantage of opportunities such as Texas Pain Society’s Annual Conference! The ability to meet various individuals within the practice of pain management, all gathered in a familiar setting here in the great state of Texas (Hook em Horns!), has definitely served as the foundation of many relationships that I will continue to hold on to as I begin my own career within this field.
 

Previous Winner of the 2021 Hassenbusch Continued Learning Case Study Presentation

Grayson Koval MD Case Study and Scholarship WinnerGrayson Koval, MD

Pain fellow at Texas Tech when award was received. 

In what ways have you used what you presented in your recent practice?
I have used my case study to remind myself of the importance of being a clinician who thoroughly evaluates his patients. 

What professional development have you gone through since your award? 
Since last year, I have finished my fellowship, been board certified in anesthesia, and started a private practice job in Midland, TX. 

Where are you working now? Midland Spine Institute in Midland, TX.

What's one piece of advice you'd give to a Fellow going into PM? Take advantage of every learning opportunity in fellowship
 


Previous Winner of the 2021 Hassenbusch Continued Learning Case Study Presentation


Adedeji Olusanya DO, MPH Case Study WinnerAdedeji Olusanya DO, MPH
  • At University of Texas Health Science Center at San Antonio when award was received. 

  • In what ways have you used what you presented in your recent practice? 
    I was able to talk about spinal stenosis and different treatment approaches on rotations 

  • What professional development have you gone through since your award?  Since the last conference, I have been able to attend more national pain conferences where I was able to net work with other fellows, and pain physicians. I also have and the opportunity to join numerous of webinars where I was able to expand my knowledge in pain medicine, patient management, and new innovative procedure to help shape the future of pain medicine.

    Where are you working now? Right now I am PGY-3  at university of Texas Health science Center at San Antonio. This year, I will be applying for the next pain fellowship cycle.

    What's one piece of advice you'd give to a Fellow going into PM? 
    I wouldn’t imagine that I could give a Fellow much advice. But what I would say to a resident or medical student that is interested in pain, is to get into research early! Also networking while attending pain conferences is vital. Interventional pain is a small field, it is important to know your colleagues!

 Previous Winner of the  2021 Hassenbusch Continued Learning Scholarship

Vishal Bansal, MD Scholarship WinnerVishal Bansal, MD 

When award was received, Dr. Bansal was 
Physical Medicine and Rehabilitation at University of Texas Health Science Center at Houston 

What professional development have you gone through since your award? 

I've been fortunate to attend the TPS for the past 3 years due to the assistance of the scholarship award. It has been a rewarding experience for me as a resident due to its educational sessions and the ability to network with pain physicians specific to Texas where I plan on practicing in the future. I am applying for pain fellowships this year, and plan to attend this year's TPS again to further network and keep myself up to date. I've been able to follow up with some of the attendees to get mentorship and additional clinical experience and prepare me for my future transition into pain medicine. It has also given me exposure to the broad scope of pain medicine that I have not seen in my residency training and sparking my interest into neuromodulation. 

Where are you working now? 
Resident Physician (PGY-3) and will be applying for Pain Medicine fellowship

What's one piece of advice you'd give to a Fellow going into PM?
One piece of advice I would have for residents considering pain medicine fellowship would be to get involved with research and attend regional and national conferences in Pain Medicine. Research or publications is often a great way for yourself to get familiar with a particular topic and to also form connections with other pain physicians. Conferences are a great way to meet future colleagues and learn about the current practices and latest advances in pain medicine, making you well equipped to start your journey into pain medicine fellowship. 


 Previous Winner of the 2019, 2020 & 2021 Hassenbusch Continued Learning Case Study Presentation

Joseph Liao MD Case Study and Scholarship WinnerJoseph Liao, M.D.

When award was received, Dr. Liao was at the University of Texas - Houston, Department of Anesthesiology

In what ways have you used what you presented in your recent practice? The majority of my studies involved interventional procedures in the treatment of refractory pain conditions. Presenting complex scenarios and receiving feedback from the physician leaders in Texas have shaped how I approach patient care, especially when it comes to patient selection and determining what next steps may possibly be offered to patients. The moderators and seasoned pain physicians at Texas Pain Society have a wealth of knowledge and invaluable experience.

What professional development have you gone through since your award? 
I am an anesthesiologist and pain management fellow at Stanford University. My goal is to offer my patients quality, best-in-class treatments. I am also working towards being more involved in industry and physician leadership. 
























































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National Opioid Awareness Day: Looking Into Opioid Addiction, The Opioid Epidemic & How To Stop Opioid Overdoses

This awareness day, focused on opioids, exists to encourage patients to only use opioids as prescribed.

pills

Recently, there has been an influx of news on the topic of opioids, the opioid epidemic, illicit fentanyl overdoses, and National Opioid Awareness Day, which falls on September 21. This awareness date urges people to learn more about these drugs, including the dangers of abusing legitimately prescribed opioids, the potentially fatal results of using or trying illicit opioids, and the proper way to handle opioid prescriptions. 

What are opioids?

Opioids are a class of drugs that are chemicals (either natural or synthetic), which interact with nerve cells and, in turn, treat pain. Also known as narcotics, they include illegal drugs like heroin, synthetics like fentanyl, and prescriptions (both natural and semi-synthetic) like oxycodone, hydrocodone, codeine, and morphine. They can come as oral pills, lozenges, oral solutions, injections, IVs, patches, or suppositories. 

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TPS Board Member Dhanalakshmi Koyyalagunta, MD

From what drew her to the pain management industry to her favorite part of being a pain doctor, Dhanalakshmi Koyyalagunta opens up in our latest profile feature!

Dhanalakshmi Koyyalagunta, MD is a Texas Pain Society Board Member and professor for the Department of Pain Medicine, Division of Anesthesiology and Critical Care, The University of Texas M.D. Anderson Cancer Center.

Area of Specialty & Special Interest: Cancer pain, opioid addiction

What got you into pain medicine? The blend of pharmacology and interventions! 

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First Ever National Fentanyl Awareness Day

r National Fentanyl Awareness Day

The first-ever National Fentanyl Awareness Day launches Tuesday, May 10, 2022.

Download Social Media Assets   #NationalFentanylAwarenessDay #FentanylAwareness Download Flyers for your Office 

Visit the National Fentanyl Awareness Day website for more information.You can find additional social media, draft emails to share with partners, key messages, and more using the official toolkit.

Founded by parents who have lost loved ones to the drug overdose epidemic, National Fentanyl Awareness Day is supported by a group of subject matter experts, corporations, nonprofits, schools, families, and elected officials who are coming together to amplify the issue via social media.

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#DEATakeBack Day April 30th

Participate in the DEA's National Prescription Drug Take Back Day | GUIDE,  Inc.

The DEA’s Take Back Day events provide an opportunity for Americans to prevent drug addiction and overdose deaths. Encourage the gathering of unused, unwanted, or expired prescription drugs to dispose of safely during the upcoming event.

When: Saturday,  April 30th 2022 – 10 AM to 2 PM

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DEA Registration

Dea Update

Federal Register Notice

Requiring Online Submission of Applications for and Renewals of DEA Registration (PDF)

ACTION: Final rule.

SUMMARY: This rulemaking amends the Drug Enforcement Administration's (DEA) regulations to now require all applications for DEA registrations, and renewal of those registrations, to be submitted online.

DATES: This final rule is effective May 11, 2022.

FOR FURTHER INFORMATION CONTACT:
Scott A. Brinks, Regulatory Drafting and Policy Support Section, Diversion Control Division, Drug Enforcement Administration; Mailing Address: 8701 Morrissette Drive, Springfield, Virginia 22152; Telephone: (571) 776–2265.

TPS President speaks with TMA about access to Naloxone

Physicians Call for Better Access to Naloxone, Treatment Programs for Opioids

Read the TMA article 

Comments Requested- CDC Moves To Relax Opioid Prescription Guidance

Below is a recap of the release announced on Forbes. Find the Proposed 2022 CDC Clinical Practice Guideline for Prescribing Opioids here. TPS will submit a formal response on behalf of TPS Members.

Send in your comments directly to TPS

The Centers for Disease Control proposed pulling back some of the strict guidelines for prescribing opioids in a draft of recommendations released Thursday, a move that would loosen some of the restrictions put in place in 2016 to help mitigate the opioid epidemic, in an attempt to allow chronic pain patients to receive more flexible treatment.

KEY FACTS

Proposed changes to the CDC’s guidance include giving doctors more leeway by slashing dose ceilings for patients and no longer suggesting they limit opioid treatment for acute pain to three days. Doctors would be advised to only prescribe opioids for painful, traumatic injuries, like major burns and those sustained in car accidents, and start patients off on low doses of immediate-release pills, according to the New York Times.

To ease less intense conditions—like episodic migraines and knee, neck and lower back pain—the new recommendations suggest employing treatments like exercise, acupuncture, heat therapy and over-the-counter drugs like ibuprofen. 

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We've gone social!

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Be sure to use #TexasPain!

 

#TakeBackDay October 23, 2021

The DEA’s Take Back Day events provide an opportunity for Americans to prevent drug addiction and overdose deaths. Encourage the gathering of unused, unwanted, or expired prescription drugs to dispose of safely during the upcoming event.

When: Saturday,  October 23, 2021 – 10 AM to 2 PM

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TPS Scientific Conference Hotel Cut Off is TODAY

 Do Not Miss Your Chance!

 

 

Notable Pain Medicine-Specific CME Presentations will focus on the most current research and findings in pain medicine. Earn up to 17 AMA PRA Category 1tm and 2.75 hours of ethics/ professional responsibility in one weekend from distinguished state and national speakers.

 LEARN MORE ABOUT THE EVENT

Get the latest information for your practice!

REGISTER NOW

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NOTICE — Important Changes to PMP Enhancement Funding

NOTICE — Important Changes to
PMP Enhancement Funding

Important changes are coming to the Texas Prescription Monitoring Program (PMP) that will affect integration and NarxCare for certain users.

The funding provided by Senate Bill 500 (86th Texas Legislature) that allowed the Texas State Board of Pharmacy to pay for statewide integration and NarxCare has not been renewed during this most recent legislative session (87th Texas Legislature).

Access to main PMP functionalities will not change. The mandate to check the Texas PMP before prescribing opioids, benzodiazepines, barbiturates, or carisoprodol also remains in effect.

The Texas PMP vendor, Appriss Health, recently sent out a message summarizing these changes to PMP users. 

Read the message from Appriss on our website to learn more and for contact information if you have additional questions. Visit txpmp.org and pharmacy.texas.gov/PMP to learn more about the PMP and to log into your PMP user account.


Virtual Session Opioid and Diversion Awareness: The Current State of the Opioid Epidemic

Virtual Session Opioid and Diversion Awareness: The Current State of the Opioid Epidemic is closed but watch for new sessions in September

This virtual Event in July has sold out. However,  the same conference will be offered again on September 7 & 16, 2021. The sign up for the September event will be sent out in the coming weeks before September. Please check the DEA Diversion website for any additional conferences.

Any questions regarding this conference may be directed to DEA Liaison Section at [email protected].

Emergency Rule Related to Issuance of Prescriptions Renewed for 30 Days

Emergency Rule Related to Issuance of Prescriptions Renewed for 30 Days

The emergency rule related to the issuance of certain prescriptions during the COVID-19 disaster has been renewed for 30 days. 

The emergency rule (§174.5) continues to allow physicians to utilize telemedicine for issuing previous prescription(s) for scheduled medications to established chronic pain patients if the prescribing physician has, within the past 90 days, seen a patient in-person or via a telemedicine visit using two-way audio and video communication. 

The emergency rule will remain in place for 30 days (until July 30, 2021 at 11:59 p.m.) or for the duration of the time period that the Governor’s disaster declaration of March 13, 2020 in response to the COVID-19 pandemic is in effect, whichever is shorter, pursuant to Section 2001.034 of the Texas Government Code. 

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We're back in person!

Meeting Registration is OPEN!

The Texas Pain Society’s Annual Scientific Meeting is the premier educational conference for pain management physicians in Texas. Each year over 200 physicians attend this one of a kind event.

Notable Pain Medicine-Specific CME Presentations will focus on the most current research and findings in pain medicine. Earn up to 17 AMA PRA Category 1tm and 2.75 hours of ethics/ professional responsibility in one weekend from distinguished state and national speakers.

1. Learn about the latest state law and rule changes from the Texas Medical Board and Texas State Board of Pharmacy and Drug Trafficking at the border

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#TakeBackDay April 24, 2021

The DEA’s Take Back Day events provide an opportunity for Americans to prevent drug addiction and overdose deaths. Encourage the gathering of unused, unwanted, or expired prescription drugs to dispose of safely during the upcoming event.

When: Saturday,  April 24, 2021 – 10 AM to 2 PM

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DEA Releases 2020 National Drug Threat Assessment


The 2020 NDTA is a valuable resource for all Americans, but especially those elected officials, law enforcement personnel, prevention and treatment specialists, and others who develop counter-drug policies, oversee law enforcement operations, and allocate resources.

 

The National Drug Threat Assessment (NDTA) is DEA’s annual comprehensive assessment of the threat posed to the United States by the trafficking and abuse of illicit drugs, the diversion and abuse of licit drugs, and the laundering of proceeds generated through illicit drug sales. 

 


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3rd Annual Interdisciplinary Pain and Opioid Crisis Seminar on April 23-24, 2021

Dr. Eduardo Bruera, Chair of Palliative, Rehabilitation, and Integrative Medicine, and Dr. Joseph Arthur, (Conference Chair), Associate Professor in Palliative, Rehabilitation, and Integrative Medicine, invite you and your colleagues to join us for this outstanding educational opportunity. We are happy to announce that registration for the 3rd Annual Interdisciplinary Pain and Opioid Crisis Seminar on April 23-24, 2021, is now open.

The 3rd Annual Interdisciplinary Pain and Opioid Crisis Seminar is CME credited for those attending in real-time. Registration is now open and in line with our mission to present accurate data for a global audience.  We hope you will join us for this outstanding educational opportunity.

This will be a great opportunity for all APRNs who attend the conference to earn credit towards their regulatory controlled substance CE requirement.

- REGISTRATION IS NOW AVAILABLE -

Please share the information about this virtual education day with your colleagues.  We look forward to seeing you in April. 

 



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